A Practical Guide to Expanding Home-Based Primary Care with Telehealth

Jill Slaboda
Liane Wardlow
Amy Wade
Karen Abrashkin
Implementation Tool
December 2019


Tools, tips, and vignettes for incorporating telehealth into home-based primary care (HBPC) models.


Although HBPC may reduce avoidable trips to the emergency department for older adults with multiple chronic conditions, this care model can be resource-intensive. This guide describes strategies for incorporating telehealth into HBPC models to help make certain aspects of care delivery more efficient and accessible. Northwell Health’s House Calls Program, an HBPC program in New York that serves homebound frail older adults, is used as an example throughout the guide. It describes the program’s experience in using a telehealth model with trained facilitators in the home, which helped reduce technical challenges for this population.

About this Tool

The guide includes practical tips, vignettes, sample workflows, and questions that can be broadly relevant for HBPC programs that want to incorporate telehealth. Sections of the guide focus on:

  • Creating a financial model to assess potential expenses and revenue streams.

  • Using information gathering to set program goals, collect information, engage stakeholders, and select telehealth vendors.

  • Developing methods for assessing organizational readiness, evaluating current workflows and implementing/monitoring new workflows.

  • Designing pilot tests, training staff, and conducting surveys to analyze the pilot program.

The guide details Northwell Health’s implementation of a facilitated telehealth model to illustrate strategies discussed in each section.


Telehealth can expand access to HBPC programs, but providers and health systems should have clear goals and resources for successful implementation.

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